Basic principles of Diagnostic

test (1)
Ideal diagnostic tests right answers:
Ideal diagnostic tests right answers:
(+) results in everyone with the disease and
( - ) results in everyone else

Clinical
prediction rules, algorithm
Usual clinical practice:
The test be studied in the same way it would be used
in the clinical setting
Observational study, and consists of:
Predictor
variable (test result)
Outcome variable (presence / absence of the disease
 Basic principles of Diagnostic
test (2)
Sensitivity, specificity
Prevalence, prior probability, predictive values
Likelihood ratios
Dichotomous scale, cutoff points (continuous
scale)
Positive (true and false), negative (true and
false)
ROC (receiver operator characteristic) curve
 Diagnostic test
general structure : 2 X 2 tables
Target disorder Target disorder
Positive Negative
(disease) (normal)
Predictor True positive False
Test TP positive
positive FP
a
b
Predictor False negative True
Test FN negative
negative TN
c
d
Sensitivity, specificity, predictive values, likelihood ratios, ROC
 EBM Issues on diagnostic tests:

Isthis evidence about the accuracy of a

diagnostic test valid?
Does this valid evidence demonstrate
an important ability to accurately
distinguish patients who do and dont
have a specific disorder?
Can I apply this valid and important
diagnostic test to a specific patient?
Validity
 Importance (1)
Does this (valid) evidence
demonstrate an important ability
of this test to accurately
distinguish patients who do and
dont have a specific disorder?

Sensitivity
Specificity
Likelihood ratios
 Specifity

If a test is 100 % specific, it reacts

positively only when the client
actually has the condition being
tested. The important factors that
can effect a false positive reaction
such as drugs.
 Sencitivity

The sencitivity of a test is the degree

to which a test detects disease
without yielding a false negative
diagnosis.
 Normal Reference Values
Normal reference values or reference
values is not as normal values
because its laboratory must
determine what is normal for a test
performed in specific laboratory
Metric Measurments Used in Laboratory Reports
Weight
Kilogram (kg) 2,2 lb
Gram (g) 453 g = 1 lb
Milligram (mg) = 1/1000 of a g
Microgram (g) = 1/1000 of a mg
Nanogram (ng) = 1/1000 of a g
Picogram (pg) = 1/1000 of a ng
Femtogram (fg) = 1/1000 of a pg
Volume
Liter (L) = 1000 ml (or 1000 cc) 1.05
qt
Deciliter (dL) = 100 ml or 1/10 of a L
Milliliter (mL) = 1 ml or 1/1000 0f a L
 Usual Test Done Automatically by Cell
Counters

Hct Hematocrit
Hb Hemoglobin
WBC White blood cells/ leukocyte
RBC Red blood cells/ eritrocyte
MCV Mean corpuscular volume
MCH Mean corpuscular hemoglobin
MCHC Mean corpuscular hemoglobin concentration
RDW Red blood cell distribution width
PLT (Plateled counts may also be performed with some
counters
Importance (2)
 Importance (3)
Odds = ratio of two probabilities
Odds = p/1-p
Probability = odds/1+odds

Likelihood ratio (+) :

Prop (+) result in people with the disease
Prop (+) result in people w/out the disease

Pretest Odds X LR = Posttest Odds

 Pretest
probability

Likelihood
ratio

Posttest
probability
The usefulness of 5 levels of
diagnostic test result
 Accuracy of the test
The accuracy of the test
depends on how well the
test separates the group
being tested into those
with and without the
disease in question
Accuracy is measured by
the area under the ROC
curve. An area of 1
represents a perfect test;
an area of 0.5 represents
a worthless test (AUC)
0.90-1.00 = excellent
(A)
0.80-0.90 = good (B)
0.70-0.80 = fair (C)
0.60-0.70 = poor (D)
0.50-0.60 = fail (F)
Applicability
 Diagnostic tests

Isnot about finding absolute truth,

but about limiting uncertainty
establishes both the necessity and the
logical base for introducing probabilities,
pragmatic test-treatment thresholds ..

Start thinking about

what youre going to do with the results of
the
diagnostic test, and
whether doing the test will help your
patients
 Conclusion

EBM is nothing more than a

framework of systematic use of
current valid study results
relevant to our patients
 End result

Self directed, life-long

learning attitude
for high quality patient
care
The Principle of diagnostic
determine :
1. Anamnestic
2. Physical Diagnostic
Auscultation, Palpation
Percution, Inspection etc
3. Diagnostic Tests :
LABORATORY
X-RAY
E.K.G
ENDOSCOPY
 Clinical Laboratory Test

1. HEMATOLOGY
2. CLINICAL CHEMISTRY
3. IMUNO SEROLOGY
4. MIKROBIOLOGY/PARASITOLOG
Y
 The useful of Laboratory
test
1. Determine of disease
2. To Help established diagnostic
3. To evaluation of disease prolong.
4. Monitoring of therapy.
5. To predict of prognostic
 Hemathology tests
1. FULL BLOOD COUNT
RBC/ERYTHROCYTE,
WBC/LEUKOCYTE, HB, HCT, MCH,
MCHC, MCV, PLT, DIFF WBC COUNT
(PMN, LYMFOCYTE, MONOCYTE), ESR.
2. BLOOD FILM
3. HEMOSTATIC TESTS :
PT.APTT,TT,FIBRINOGEN
4. RETICULOCYTE COUNT
5. BONE MARROW ASPIRATION
 Clinical Chemystri Tests :
1. Liver Function Tests : GGT, ALT/SGPT, AST/SGOT,
BILIRUBIN TOTAL, BIL. DIRECT/INDIRECT, ALKALI
PHOSPHATASE, TOTAL PROTEIN, ALBUMIN, GLOBULIN
2. Diabetic Mellitus Tests: GLUKOSE (PUASA,PP2
JAM,OGTT), HbA1c
3. Renal Function Test: UREUM,KREATININ CLEARANCE
UREUM,CREATININ
4. Cardiac Enzyme Tests: CK, CKMB, MYOGLOBIN,
LDH).
5. Blood Lipid tests: TG, TOTAL CHOLESTEROL,
HDL/LDL CHOLESTEROL, LIPOPROTEIN, APO A,B,C .
6. Uric Acid
7. ELEKTROLYTE (K,Na,CL) MINERAL (Ca.Mg,P) DLL
 IMUNOSEROLOGI TESTS
1. Virus Infection Tests:
VIRAL HEPATITIS A (Ig M,igG HAV)
VIRAL HEPATITIS B (HbsAg .Anti HBS, HBeAg Anti
HBe,HBV DNA)
VIRAL HEPATITIS C(Anti HCV)
Tes HIV, DHF, TORCH, DLL.
2. Bacterical Infection Tests (WIDAL,
VDRL,TPHA, MYCODOT, ETC)
3. Paracyte Infection Tests (ICT
PLASMODIUM VIVAX, FALCIPARUM ETC)
4. Hormonal Tests (TSH, FT 4, ETC)
5. Tumor Markers Tests : (CEA, AFP, PSA,
CA 125, ETC)
 MIKROBIOLOGY/PARASITOLOGY
TESTS :

1. IDENTIFICATION DAN ISOLATION

TEST (CULTUR, BIOKIMIA)
2. MICROSCOPYC TESTS (GRAM,
ZIEHL NILSEN, NEISSER ETC)
3. P.C.R TEST
4. BLOOD FILM THIN/THICK
(MORFOLOGY PLASMODIUM,
AMOEBA, HELMINTHES, YEAST ETC
5. IMUNOLOGY/SEROLOGY
 Routine Urinalysis and Other
Urine Tests :
pH
Specific Gravity
Protein
Sugar
Ketones
Sediment (crystals, casts, WBCs, RBCs )
Leukocyte Esterase
Urinary Porphyrins
Bilirubin
Urobilinogen
Nitrites